F.E.A.S.T's Around The Dinner Table forum

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Tahirua27
We are waiting to begin FBT later this month but have been working since coming out of hospital 2 weeks ago to follow as much of an FBT mealplan and process as we can.

My AN daughter is now in her recommended ideal weight range and has been holding that weight since she left hospital and has been following her programme pretty well, motivated solely by the carrot of seeing friends. Today though she totally lost it after her weekly GP check-in, telling me that she is utterly sick of people focusing on food and weight, that she just feels worse and worse in herself, feels totally unsupported (that is hard to hear given that her father and I have dropped utterly everything to support her and her sister, also struggling with undereating), and can't see the point in anything. She has refused two snacks and one meal so far today, with dinner coming up next. She says she will refuse to go to the GP again for her weekly check-ins and will refuse to go to the FBT psychologist for an interim appointment this week as she sees utterly no point,

Before we went into hospital, she was seeing a psychologist and a dietitian where some cognitive work started to be done, but she was not engaged in it at all and I felt it was the wrong approach while she was still not WR and the anorexia was very strong (at that point insisting on being a vegan), hence the move I've made to FBT.

From what I've seen on the forums, FBT seems like it is still mainly focused on eating rather than helping with the mental challenges directly - as I understand it, this is because the idea is that the mental processes will eventually improve if the brain gets nourished again?

How do I give my daughter hope that we can support and help her with her mental anguish while we all seem to her so obsessed with food? How do I encourage her to stay the course? Can I be sure the course will work with no mental lift seen yet? Are there any other options?

Thank you so much.
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Foodsupport_AUS
This sounds really typical and normal at the moment. FBT although focusing initially on weight restoration does also focus on other issues too. Part of the process is handing back feeding back to the child along with dealing with other mental health issues. 

Her anxiety - losing it - is part of her illness. It is common as they approach their appropriate weight - she may need to gain further- anxiety peaks. Often resulting in feeling worse than ever. It is unfortunately all part of the process. There is no medicine, no talking, no discussion at this point that is going to make her feel more comfortable in her skin. Regular food and nutrition, learning some CBT type and DBT type skills can all be helpful in the long run but it is unfortunately a slow process. 

When D loses it, I think acknowledge her frustration that weight and physical health are being seen as more important than her mental health, but assure her it is a priority as well. What she won't want to hear, so I probably wouldn't bother is that consistent nutrition over months is going improve her brain and thinking. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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deenl
Hi 
 
Tahirua27

I found that, while there were constant improvements, it really took a couple of months at a good weight for the ED thoughs to ease. Phychological recovery nearly always lags behind physical recovery. Due to a whole combination of factors we had to take a slow and steady approach to nutritional rehabilitation but medical oversight was the one aspect that I made absolutely no concessions on. It is the safety net to keep our kids on track and I have to say that for me, it stopped me from easing off too early due to exhaustion and burnout.

If your team is following a formal FBT protocol then phase 1 weight and nutritional restoration through regular and sufficient food, phase 2 is getting food consumption back to a more normal, age appropriate footing e.g. young kids will still eat what mom/dad makes but older teens will be training for when they live away from home and phase 3 is dealing with any other issues such other mental, social, educational, relationship issues. Sometimes when the other issues are interfering with phase 1 or 2 then the other issues will be dealt with earlier in the process.

One more thing ... Professionals are notorious at setting target weights too low. Are you absolutely sure that she is at the right weight for HER. The target should be bassed on her historical trends, not just a population average. Generally, the 2 years before ED diagnosis are not considered part of the trend as most of our kids are slipping long before diagnosis. Here is a recent thread with lots of helpful articles on the topic.

Warm wishes,

D

2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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tina72
"She says she will refuse to go to the GP again for her weekly check-ins and will refuse to go to the FBT psychologist for an interim appointment this week as she sees utterly no point,"

Make sure that NOT going there is NO OPTION. She needs to go and if she still refuses meals that makes clear that the concentration on food and meals is stil needed as she is still very sick.

If she still feels not better that can mean that a) the weight range is not her ideal body weight range and she needs to gain some more weight (in our case it was just 1-2 kg more to see a difference) or b) the time to rewire the damaged brain was not enough up to now. In most cases improvement starts about 4-6 month after a good weight is reached.


Keep feeding. There is light at the end of the tunnel.
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scaredmom
Tahirua27 wrote:

My AN daughter is now in her recommended ideal weight range and has been holding that weight since she left hospital and has been following her programme pretty well, motivated solely by the carrot of seeing friends. 

Deenl's and Foodsupport's replies and the thread deenl posted are really helpful. She may not be at the right weight for herself at this time.

.
Tahirua27 wrote:


 Today though she totally lost it after her weekly GP check-in, telling me that she is utterly sick of people focusing on food and weight, that she just feels worse and worse in herself, feels totally unsupported (that is hard to hear given that her father and I have dropped utterly everything to support her and her sister, also struggling with undereating), and can't see the point in anything. She has refused two snacks and one meal so far today, with dinner coming up next. She says she will refuse to go to the GP again for her weekly check-ins and will refuse to go to the FBT psychologist for an interim appointment this week as she sees utterly no point.


OH yah that is ED speaking really clearly. ED knows you are on it and it is coming out. She still may need more weight. And it is still very early for her for the brain stabilisation/healing. If you expect her to go, and I hope you do, there is no other option but to go. It is just a given. No need to discuss it right now with her. The days of appointments were alway fraught with upset. I just learned not to say anything, and remain not just calm but "zen". If I was nonplussed, she saw that I could not be riled up and she nothing to fuss about with me. It seems she is very scared and that is part of ED. You just have to get it done and continue. It does get better, really, it does. 

Tahirua27 wrote:

From what I've seen on the forums, FBT seems like it is still mainly focused on eating rather than helping with the mental challenges directly - as I understand it, this is because the idea is that the mental processes will eventually improve if the brain gets nourished again?

How do I give my daughter hope that we can support and help her with her mental anguish while we all seem to her so obsessed with food? How do I encourage her to stay the course? Can I be sure the course will work with no mental lift seen yet? Are there any other options?

Thank you so much.


So yes she needs to have a properly nourished brain before it can heal and then it takes months to see the beginnings of the brain improvements. There may not be anything you can say to her at this point. Ed is fighting you. You have to be obsessed with food just as she is/was obsessed about not eating it. No one has a magic crystal ball to know what will work in any given situation. But you take a chance and FBT is evidence based, you can try it and evaluate it over time and see if you need to tweak things or not.

As for missing meals today, do you have a plan to make that up? Many of us needed to ensure they had a supplement or even go to the hospital if need be to ensure proper nutrition every day, every single day for a long , long time.
I know it sucks. It really does. It is hard and it is not logical a lot of the time. It can be maddening. So ensure you get a bit time for yourself too.
XXX
Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Mamaroo
My d also hated her weekly medical appointments, I used to say either she cried on the way home or I did. On the day of her appointment, she would also not follow her mealplan, but was able to bounce back the next day. I hope tomorrow will be better. As my d's weight went up her anxiety and depression went up too. It was only after several months post WR did her anxiety and depression start to reduce. Only after several months post WR did the hospital offer psychological appointments and she only had to go a couple of times, before the psychologists said it wasn't necessary any more. Hang in there, just present the meals and snacks as per normal with the expectation that it will be eaten. 

I told my d that we needed to focus on the food until she's better, then life could return to normal where there would be only a small focus on food and a lot of focus on the rest of her life.
D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. She is back to her old happy self and can eat anything put in front of her.
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Tahirua27
Thank you so much everyone! Great advice 🙂
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